By Dr Ananya Mandal, MD
Around 3 to 5% of the world population suffers from a widespread painful disorder called fibromyalgia. Females are affected more often than males. There are multiple tender points and other symptoms like sleep disturbances, irritable bowel syndrome, headaches and fatigue that may severely disable the patient and interfere with daily functioning affecting quality of life.
For each individual the symptoms and time course are variable and may wax and wane with time, never really going away. Treatment thus aims at keeping the symptoms to the minimum. The condition is not curable.
Management can be divided into classes that include:-
The main problem that medications can treat in patients with fibromyalgia is pain.
The most commonly used agents are thus pain relievers that belong to the class of Nonsteroidal anti-inﬂammatory drugs (NSAIDs). NSAIDs like paracetamol may benefit patients with fibromyalgia when used in combination with Tramadol - a synthetic opioid and a weak opioid agonist.
Antidepressants work by raising brain levels of neurotransmitters. Drugs used in this class include tricyclic antidepressants (like Amytriptylline), Selective serotonin reuptake inhibitors (SSRIs) (like Fluoxetine) and Serotonin-noradrenaline reuptake inhibitors (like Duloxetine, venlafaxine, milnacipran etc.).
Tricyclic antidepressants such as amitriptyline are useful in chronic tension-type headache, ﬁbromyalgia and muscle spasm associated pain. SSRIs improve pain, sleep, and sense of well-being.
Muscle relaxants or Alpha-2 adrenergic agonists – drugs of this class include clonidine and tizanidine. Tizanidine helps in relieving muscle spasm and easing pain.
Anticonvulsants – Pregabalin is a drug used in epilepsy and has shown benefits in managing fibromyalgia.
Physical therapy and exercise
Exercise is one of the most important aspects of the treatment of fibromyalgia. Exercises increase flexibility, improve function and also help in improvement of mood, self reliance and reduction of pain.
Cognitive behavioral therapy
This focuses on stress reduction and other behavioral approaches to ease the pain and improve other symptoms. Stress reduction techniques, including cognitive-behavioral programs, meditation, progressive relaxation training, and biofeedback.
Other therapies include acupuncture that may relieve pain in both myofascial pain and fibromyalgia. Others include massage, transcutaneous electrical nerve stimulation, and ultrasound therapy.
Reviewed by April Cashin-Garbutt, BA Hons (Cantab)